Septal Myotomy or Myectomy

The heart is a muscular organ that pumps blood throughout the body. A condition called hypertrophic cardiomyopathy (HCM) is characterised by thickening of the heart muscles, making it difficult for the heart to pump blood. This causes shortness of breath and abnormal heart rhythms (arrhythmia). A septal myotomy or myectomy is a surgical procedure performed to treat HCM by removing a part of the thickened heart muscle.

Indications

Septal myectomy is considered for treating HCM when

Your symptoms are severe
You don’t respond to medical therapy
Outlet of blood to the aorta is severely obstructed

Procedure

Septal myectomy is an open-heart surgery that is performed under general anaesthesia (where you are put to sleep). Your surgeon makes a 6 to 8 inch long incision in the centre of the chest and separates the breastbone to access the heart. Your heart is connected to a heart-lung bypass machine (device that redirects blood away from the heart and takes over its pumping action) to keep your heart still while performing the surgery. Your surgeon then inserts a cannula (a thin tube) into the aorta, and reaches the heart through the aortic valve so no incision to the heart is required. Once the heart is accessed, a portion of the thickened heart muscle is cut and removed. Temporary pacing wires may be inserted into your heart to deliver electrical impulses and regulate heart rhythm until recovery along with a chest tube to drain fluids. The separated breastbone is then closed with special sternal wires and the chest incision is closed with absorbable sutures. The surgery takes around 3 to 6 hours to complete.

Post-operative care

Following surgery, you can go home after 5 to 7 days. Your surgeon will closely monitor your heartbeat and if needed, will provide additional treatment with a device called an implantable cardioverter-defibrillator (ICD) to ensure that your heart rhythm is normal. Your surgeon will give you instructions on medications, lifestyle modifications, resuming activities, driving, and returning to work. You will also be given instructions regarding your follow-up appointments. Complete recovery takes about 6 to 8 weeks.

Risks and complications

Although septal myectomy is considered safe and successful, like all surgical procedures, it may be associated with certain complications:

Infection
Irregular heart rhythm
Chest pain
Complete heart block that limits the heart’s ability to pump blood, which may result in sudden cardiac arrest and death
Ventricular septal defect (a hole in the wall between the right and left ventricles)
Injury to the aortic or mitral valves
Partial or incomplete removal of the ventricular outflow obstruction